Stop smoking interventions in secondary care A brief overview

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Stop smoking interventions in secondary
careA brief overview
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Aims of stop smoking interventions in secondary
care

• To embed assessment of smoking status and offer
  of support into every clinical contact between
  HCP and smoker
• To improve referral rates to the most effective
  forms of support (i.e. NHS LSSS medication)
• To offer clinical support to smokers who are in
  hospital and experiencing forced abstinence
• To monitor the effects of these activities

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The clinical case

• Smoking significantly affects
• Cardiopulmonary function1
• The immune system1
• Wound healing1
• Cellular oxygenation1
• Post operative recovery times2
• Patients who smoke and experience forced
  abstinence in hospital will be at risk of
  experiencing physical withdrawal symptoms
  potentially detrimental to their intervention and
  hospitalisation34

• Møller et al, 2006
• Møller et al, 2002
• Hughes 2006
• Hughes 2007

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The cost efficacy case

• Significant saving to bed days
• NICE commissioning tool

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The theoretical case

• PRIME theory
• Maximising the potential of the teachable
  moment

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The health care professional case

• Duty of care
• Silence kills campaign
• Welsh survey smoking status recorded in 25 of
  pre operative cases5.
• Australian research 39 of smokers received
  information/advice from their anaesthetist about
  smoking and risk perioperatively6
• Advice from surgeons or GPs is reportedly less
  likely than from anaesthetists78

5. Simmonds et al 2000 6. Wolfenden et al 2005 7.
Rissel et al 2002 8. Myles et al 2002
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Patient case

• Patients expect to be told about hospital related
  risks and benefits (choose and book, informed
  consent etc)
• Patients expect to be spoken with about smoking
  and they dont mind or feel judged as long as it
  is part of a clinical assessment (and normalised)

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Very brief advice model
Secondary care and smoking leaflet
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The Pilot

• Hospital/unit LSSS sign up (commitment from
  Champion and coordinator)
• Attended event (London Novotel June 24th )
• Receive pack and supportive materials at event
• Undertake pre implementation assessments of 50
  admitted patients who smoke
• Implement checklist plan of action
• Undertake post implementation assessments of 50
  admitted patients who smoke at 3, 6 and 12 months
  post implementation
• LSSS undertakes follow up of these cohorts of
  patients 4 weeks, 6 months and 12 months after
  leaving hospital to measure
• Level of intervention in hospital
• Smoking status and changes (date of quit date
  of admission date of intervention date of
  discharge)
• Clinical outputs of hospital intervention
  (readmission, complication rates etc)

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The Process Checklist

• Ensure that GPs have mechanisms to refer
  pre-operative patients, and have copies of the
  planned hospital admission care pathway
• Organise a hospital staff meeting Aiming for
  senior management level support for process of
  embedding interventions
• Identify a hospital champion to be key link
  with Stop Smoking Service
• Ensure that all hospital letters contain
  information about the smokefree policy, as well
  as info on how to access LSSS
• Ensure that all staff are trained to deliver very
  brief interventions and have formal mechanisms
  for referring to LSSS

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The Checklist (continued)

• Promote wide distribution and prominence of
  leaflets/posters on seeking support to quit
  smoking
• Ensure availability of pharmacotherapy through
  hospital formularies
• Processes in place to feedback to GPs and other
  healthcare providers